Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $57.54 / $107.15	Professional		$44.67	$57.54	$107.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $20.89 / $42.66	Professional	26	$15.85	$20.89	$42.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $37.15 / $64.57	Professional	TC	$26.92	$37.15	$64.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $26.92 / $56.23	Professional		$26.92	$26.92	$56.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $10.47 / $22.91	Professional	26	$10.47	$10.47	$22.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $16.60 / $33.88	Professional	TC	$16.60	$16.60	$33.88
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $72.44 / $85.11	Professional		$22.39	$72.44	$85.11
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $21.38 / $23.99	Professional	26	$20.42	$21.38	$23.99
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $58.88 / $61.66	Professional	TC	$56.23	$58.88	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $43.65 / $123.03	Professional		$27.54	$43.65	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $15.14 / $44.67	Professional	26	$11.48	$15.14	$44.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $29.51 / $79.43	Professional	TC	$14.79	$29.51	$79.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $100.00 / $114.82	Professional		$81.28	$100.00	$114.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $28.84 / $33.11	Professional	26	$23.99	$28.84	$33.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $69.18 / $83.18	Professional	TC	$57.54	$69.18	$83.18
Medcost Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $22.39 / $22.39	Professional		$22.39	$22.39	$22.39
Sentara Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $66.07 / $117.49	Professional		$31.62	$66.07	$117.49
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $26.30 / $46.77	Professional	26	$23.44	$26.30	$46.77
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $42.66 / $91.20	Professional	TC	$27.54	$42.66	$91.20
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $69.18 / $128.82	Professional		$39.81	$69.18	$128.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $26.30 / $52.48	Professional	26	$15.85	$26.30	$52.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $38.90 / $77.62	Professional	TC	$21.38	$38.90	$77.62